Provider Demographics
NPI:1831292804
Name:ADVANCED PODIATRIC SPECIALISTS, PC
Entity Type:Organization
Organization Name:ADVANCED PODIATRIC SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:ARENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-757-9200
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-757-9200
Mailing Address - Fax:203-757-3990
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-757-9200
Practice Address - Fax:203-757-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00007213E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01632Medicare PIN